From The State Capitals: The ACA At Three

As the health law marks its third anniversary, much of the action surrounding its implementation has shifted to the states.

Hot topics include creation of health exchanges, the on-line marketplaces where consumers will be able to shop for insurance coverage, and the law’s Medicaid expansion, a key mechanism by which the overhaul will extend health care to millions of people who currently lack health insurance.

We checked in with reporters on the ground in Colorado, Florida and Minnesota to find out what they view as the most significant developments to happen in their states since the law’s passage and what future challenges they see ahead.

Via Skype:
Lynn Hatter

LYNN HATTER, WFSU:  I’m Lynn Hatter from WFSU-FM in Tallahassee, Fla. One of the biggest developments in the past three years has been the state’s rejection of the Medicaid expansion under the Affordable Care Act. Florida lawmakers say they don’t want to move forward with that and are now proposing their own plan to submit to the federal government that would cover roughly the same 1 million Floridians who would have otherwise been eligible.  A plan should be coming on that within the next week.

One of the biggest challenges the state will face will be how to put it all together. Obviously, Florida is looking to do its own state-run program, and that’s going to come with getting approval from the federal government in order to take the Medicaid expansion money. The state is also looking at how to comply with the law in the area on insurance regulation, and Florida will be deferring to the federal government like premium increases, rate increases and other insurance regulations.

Via Skype:
Elizabeth Stawicki
Minnesota Public Radio

ELIZABETH STAWICKI, MINNESOTA PUBLIC RADIO: My name is Elizabeth Stawicki, and I’m a health care reform reporter at Minnesota Public Radio in St. Paul. The most significant issue that’s happened here since the law passed three years ago has been getting our legislation passed to create a state-based health insurance exchange. We’re one of the few states that actually has done this.

This began, though, three years ago. But, because Republicans were in control the first two years of the legislature, they wanted to block the creation of the health insurance exchange, because they were against the Affordable Care Act and thought that either the U.S. Supreme Court would strike it down or there would be a different president in the White House.

But, just this week our Legislature has passed this exchange legislation, and, as I am talking to you in mid-March, we believe that the governor will sign that legislation into law.

The challenges that I foresee in the coming year here again have to do mostly with the insurance exchange. Our state health plans that want to sell on the exchange have only until May 17 to get approval from the state — which doesn’t leave them a whole a lot of time — but that’s necessary in order for the state to begin enrolling Medicaid members and for people to start using the exchange to compare plans on Oct. 1.

Via Skype:
Eric Whitney
Colorado Public Radio

ERIC WHITNEY, COLORADO PUBLIC RADIO: I’m Eric Whitney of Colorado Public Radio in Denver. The most significant thing to happen since the passage of the Affordable Care Act here was in 2011 when the state legislature passed a bipartisan health exchange bill that established the health insurance exchange in Colorado. There was a lot of debate over whether that was actually going to work or not, but the fact that it passed allowed the health insurance exchange to get started and go forward.

It did get a handful of Republican votes. The people who did vote for it – the Republican co-sponsors – took a lot of heat from more conservative members of their party. There was some concern over whether they would be ousted and whether Republicans would be able to muster the votes to derail the startup of the exchange in Colorado. The 2012 elections were also significant because that didn’t happen: The Republican supporters of the bill managed to survive their challenges. Also, the fact that the Obama administration kept the White House in 2012 meant that it was very clear that the exchange was going to be established and continue in Colorado.

Right now the most significant challenge for the exchange in Colorado – and I think the most significant thing for health reform going forward in Colorado – is finding an ongoing source of funding for the exchange’s operations. In 2015, state exchanges have to be self-sustaining, so right now the exchange board and the legislature are looking for ways to fund its ongoing operations. There’s been some work on that already – the exchange board has passed an administrative fee – but they have to go to the legislature to try to find some other funding mechanisms. And that debate is just starting up in Colorado, so that’s what I’m going to be watching closely.

Related Topics

Insurance Medicaid States The Health Law